Working with the Community to Reduce New HIV Infections Among Gay and Bisexual Men and Transgender Women

"The United States cannot reduce the number of HIV infections nationally without better addressing HIV among gay and bisexual men."

So declares the National HIV/AIDS Strategy (NHAS), boldly and accurately. According to the Centers for Disease Control and Prevention, gay men make up approximately 2 percent of the U.S. population, but account for 53 percent of all new HIV infections. That translates into nearly 29,000 persons newly infected with HIV every year in the U.S. In fact, men who have sex with men1 (including both gay identified and non-gay identified men) are the only risk group in the U.S. in which new HIV infections are increasing. Gay men from all racial and ethnic backgrounds continue to be the risk group most severely affected by HIV in the U.S. White MSM represent the largest number of new HIV infections, but Black and Latino gay men are at disproportionate risk for infection. That is why the NHAS makes a clear statement on the need to improve HIV prevention services for gay and bisexual men and transgender individuals.

The Strategy also observes that "[t]he burden of addressing the HIV epidemic among gay and bisexual men and transgender individuals does not rest with the government alone." As Jeffrey Crowley, Director of the Office of National AIDS Policy at the White House, has often noted, the Strategy is a national, and not a Federal, strategy. That means everyone has a role to play in achieving the goals of the NHAS, including community leaders, service providers, professional organizations, faith-based organizations, business leaders, and concerned citizens from all walks of life.

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As part of our commitment to expand and strengthen efforts across the nation directed toward reducing new HIV infections among MSM and transgender women, the Department of Health and Human Services (HHS) convened a two-day meeting last week with dozens of representatives from national lesbian, gay, bisexual, and transgender (LGBT) organizations. Some of those organizations are engaged in HIV-related work, while others are not currently actively involved in that arena. Through a series of large and small group discussions, we explored ways to better promote HIV/AIDS awareness and actively engage the broad diversity of LGBT community leadership in raising awareness about the ongoing toll of HIV/AIDS and to strategize about ways to promote health.

Many complicated issues were raised during the meeting, reflecting the diversity of the various communities that fall under the heading of "LGBT". In particular, concerns were raised about the need to improve surveillance systems so that we have an accurate estimate of the number of transgender individuals -- especially transgender women -- who are living with HIV/AIDS. Our discussions also surfaced the need to provide, in a timely manner, basic information to organizations and opinion leaders who may not be familiar with HIV/AIDS statistics in their communities. For example, how many HIV infections have occurred among American Indian/Alaska Native MSM and how many HIV infections have occurred among Native Hawaiian/Pacific Islander MSM? And several participants reminded us of the distinctive health needs of both younger and older gay men.

It wouldn't be accurate to say that we were able to resolve all of the complex issues raised during our two-day discussion. But the free exchange of ideas and frank perspectives that were raised by participants helps pave the way for more targeted discussions in the future. As expressed by Christopher Bates, the Executive Director of the Presidential Advisory Council on HIV/AIDS, "This meeting was a significant milestone in our continued efforts to dialogue with gay, bisexual, lesbian and transgender communities about the critical subject of health."

In addition to providing useful feedback to the Federal government, it is our hope that the consultation helped to foster new organizational alliances across the rich variety of organizations serving the LGBT communities. After all, everyone's contribution will be necessary in order to achieve the goals of the NHAS.

What are your ideas about re-energizing LGBT community efforts around HIV prevention and health promotion for gay, lesbian, bisexual, and transgender persons? Share your thoughts in the comments section below.

The term "men who have sex with men" (MSM) is used in CDC public health surveillance systems. It indicates the behaviors that transmit HIV infection, rather than how individuals self-identify in terms of their sexuality. The term is inclusive of all men who have sex with men, even those who do not identify as gay or bisexual.

Ronald Valdiserri, M.D., M.P.H., is the deputy assistant secretary for health, infectious diseases at the U.S. Department of Health and Human Services.

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